Multimorbidity, healthcare use and catastrophic health expenditure by households in India: a cross-section analysis of self-reported morbidity from national sample survey data 2017–18

Abstract

Background The purpose of this research is to generate new evidence on the economic consequences of multimorbidity on households in terms of out-of-pocket (OOP) expenditures and their implications for catastrophic OOP expenditure. Methods We analyzed Social Consumption Health data from National Sample Survey Organization (NSSO) 75th round conducted in the year 2017–2018 in India. The sample included 1,13,823 households (64,552 rural and 49,271 urban) through a multistage stratified random sampling process. Prevalence of multimorbidity and related OOP expenditure were estimated. Using Coarsened Exact Matching (CEM) we estimated the mean OOP expenditure for individuals reporting multimorbidity and single morbidity for each episode of outpatient visits and hospital admission. We also estimated implications in terms of catastrophic OOP expenditure for households. Results Results suggest that outpatient OOP expenditure is invariably lower in the presence of multimorbidity as compared with single conditions of the selected Non-Communicable Diseases(NCDs) (overall, INR 720 [USD 11.3] for multimorbidity vs. INR 880 [USD 14.8] for single). In the case of hospitalization, the OOP expenditures were mostly higher for the same NCD conditions in the presence of multimorbidity as compared with single conditions, except for cancers and cardiovascular diseases. For cancers and cardiovascular, OOP expenditures in the presence of multimorbidity were lower by 39% and 14% respectively). Furthermore, around 46.7% (46.674—46.676) households reported incurring catastrophic spending (10% threshold) because of any NCD in the standalone disease scenario which rose to 63.3% (63.359–63.361) under the multimorbidity scenario. The catastrophic implications of cancer among individual diseases was the highest. Conclusions Multimorbidity leads to high and catastrophic OOP payments by households and treatment of high expenditure diseases like cancers and cardiovascular are under-financed by households in the presence of competing multimorbidity conditions. Multimorbidity should be considered as an integrated treatment strategy under the existing financial risk protection measures (Ayushman Bharat) to reduce the burden of household OOP expenditure at the country level.

The moderating effect of mental health and health insurance ownership on the relationships between physical multimorbidity and healthcare utilisation and catastrophic health expenditure in India

“…The findings also highlight that respondents with physical multimorbidity had a higher likelihood to experience CHE unconditionally on their mental health or ownership of health insurance, consistent with prior literature reporting higher health expenses and CHE in individuals with multimorbidity [ 6 , 8 , 9 ]. Having an additional mental health condition further strengthened the adverse outcome.…”

“…Patients with multimorbidity, especially those with both mental and physical conditions, have complex health needs [ 5 ], which require the significant use of healthcare services [ 6 , 7 ]. Moreover, since multimorbidity is a lifelong condition, these individuals face higher healthcare expenditures and a higher likelihood of catastrophic health expenditure (CHE) [ 6 , 8 , 9 ]. Multimorbidity also poses a significant impact on work productivity, pushing affected patients and their families into poverty [ 10 ].…”

Out-of-pocket expenditures associated with double disease burden in Pakistan: a quantile regression analysis

“…Evidence suggests that individuals with multimorbidity in noncommunicable diseases incur significantly higher average out-of-pocket expenditures than those with single morbidity, particularly in the case of hospitalization [ 11 ]. The adverse effects of multimorbidity in noncommunicable diseases are significant among elderly individuals, females, and urban areas [ 12 ].…”

“…First, it focuses on double diseases, which encompass the presence of both communicable and noncommunicable diseases. In contrast, previous research has typically measured multimorbidity based on the presence of one or more communicable diseases or noncommunicable diseases [ 11 , 12 , 24 ]. Second, unlike previous studies that analyzed the effect of multimorbidity on outcome variables using average household out-of-pocket expenditure or population data, this research employs a quantile regression approach to examine the distribution of OOP expenditure associated with double diseases [ 11 ].…”

“…In contrast, previous research has typically measured multimorbidity based on the presence of one or more communicable diseases or noncommunicable diseases [ 11 , 12 , 24 ]. Second, unlike previous studies that analyzed the effect of multimorbidity on outcome variables using average household out-of-pocket expenditure or population data, this research employs a quantile regression approach to examine the distribution of OOP expenditure associated with double diseases [ 11 ]. This approach offers advantages over other empirical models, such as ordinary least squares or generalized linear regression, as it provides coefficients that vary across households or the population [ 12 ].…”